International Journal of Anatomical Sciences 2012, 3(2): 33-35

Research Paper

Obliteration of the Lumen of the Vermiform Appendix

Swayam Jothi S, Jacintha Antony, Anuradha S, Hemanth Kommuru, Rajaeswara Rao N, Sujatha N.

Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam 603 108, Tamil Nadu, India.

Key words: Appendix. Obliteration of lumen, Lymphoid infiltration

Abstract: – The appendix being the common site for inflammation, an idea came to the mind that if the lumen is obliterated whether we can prevent inflammation.   With this idea at the back of the mind a study was made in appendices which showed obliteration of the lumen or a very little lumen. 228 biopsy specimens sent to the pathology department of our college during the past 1 and 1/2 years were used for the study. We observed that 40 specimens showed narrowing of the lumen which was further classified into total obliteration which was observed in 12 specimens, slit like lumen in 21 cases and a very small lumen in 7 cases.    The incidence was more in chronic inflammation and in males.  The obliteration of the lumen of appendix was more common in the age group ranging from 20- 40 years during which time the lymphoid infiltration is also more due to repeated infections

The appendix being the common site for inflammation, the present study was carried out to analyze whether obliteration of lumen or very little lumen has any relation to inflammation.

 Materials and Methods

228 biopsy specimens sent to the pathology department of our college during the past 1 and 1/2 years were made use for the study.

Observations

 40 specimens showed narrowing of the lumen which was further classified into a very small lumen in 7(17.5%) cases (Fig. 1), slit like lumen in 21(52.5%) cases (Fig. 2) and total obliteration in 12(30%) specimens

(Fig. 3)

Range of Age No of cases

01-10

-

11-20

06

21-30

12

31-40

12

41-50

08

51-60

Nil

61-70

02

 

Table  1  The  age  incidence  of  obliteration  of lumen in vermiform appendix

The age incidence of obliteration of lumen  was  more  during  21  to  40  years (Table 1)
Table 2 Incidence of nature of inflammation
Nature of Inflammation No. of cases
Chronic 32
Acute 066
Actue in a previouslychronic condition 02

The incidence of obliteration of the lumen was more in chronic inflammation (Table-2)

Sex No. of Cases
Male 24 cases
Female 16 cases

 

Table 3 Sex prevalence in obliteration of vermiform appendixThe  sex  prevalence  is  more  (24  cases)  in males and less (16 cases) in females (Table 3)Table 4 Length of appendices studied

Length of the Appendix No of Cases
2-4 cm 12
4-6cm 20
6-8cm 07
8-10cm 01

 

The obliteration of the lumen of appendix was more in the shorter specimens whose length was not greater than 6 cm (Table-4)

image002

 

 

 

 

 

 

 

 

Fig. 1 Appendix with small lumen

Discussion

Some  of  the  findings  reported  by  Collins (1936) were as follows: In a series of  1054   specimens   39%   showed   varying degrees of lumen obliteration; 61.4% were males and 38.5% were females.   In the present  study  of  228  specimens,  40  cases (17.6%) showed varying degrees of obliteration.  60% were males and 40%were females. According to Collins (1936) there were 254 appendices (24.2%) less than 6cm in   length.   In   this   study,   the   shorter specimens revealed higher percentage of obliteration than those specimens whose length was more than 6cm.In the present study there were 32(80%) appendices  less than 6cm in length out of 40 appendix specimens. The incidence of obliteration of appendix lumen was more in chronic appendicitis which was also associated with lymphoid proliferation.   Maximow (1930), Palmer and Higgins (1993) all agree that fibroblasts may arise from lymphocytes. Mallory (1929) has clearly shown that endothelium also serves as a source of reticulum production. These two cellular elements are important factors in the production of obliteration

Fig. 2 Appendix with slit like lumen

 

image004

Fig 3 Appendix with obliterated lumen Jothi SD. Obliteration of the lumen of the vermiform appendix

image006

 

 

 

 

 

 

 

 

Conclusion

The  age  of  incidence  ranged  from   20–40 years. This is too early for physiological involution of the lumen of appendix.  The presence of varying number of lymphoid follicles and higher incidence of occlusion in chronic appendicitis favors inflammatory   cause   for   obliteration   of lumen.   If appendix inflammation can be managed conservatively it may lead to occlusion of lumen of appendix. The obliteration of the lumen of appendix was more common  in  age  group  ranging from  20-40 years during which time the lymphoid infiltration is also more due to repeated infection.

References Collins DC (1936) Mechanism and significance of obliteration of the lumen of the vermiform appendix. Annals of Surgery, 104: 199–211.

Mallory,  FB  (1929)  The  principles  of  pathologic

History,  Philadelphia,  W.B.  Saunders  Co.  pp 486-487.

Maximow, Alexander: (1930) A text – book of histology, Philadelphia, W.B. Saunders Co. PP.117–150,

Palmer BM and Higgins GM (1993) A study of the clasmatocytes in the Sacrospinalis Muscle of the Rabit. Am. J Med Sci, 85:191-196,